The perception of a rhythmic, mechanical sound inside your head, often described as a whooshing, thumping, or a sound resembling a helicopter rotor, is a distinct medical symptom. Unlike the more common, continuous ringing in the ears, this pulsating noise is often a real sound generated within the body that the ear perceives. The medical term for this is Pulsatile Tinnitus (PT), and it accounts for a small percentage of all tinnitus cases. This rhythmic sound is synchronized with the patient’s heart rate, immediately suggesting an underlying vascular or circulatory cause requiring medical evaluation.
Defining Pulsatile Tinnitus
PT is characterized by a sound that beats in time with the person’s pulse, which differentiates it from non-pulsatile tinnitus (a steady ringing or buzzing). While non-pulsatile tinnitus is usually subjective, PT often has a physical, mechanical source. In many cases, a doctor can hear the sound using a stethoscope placed near the ear or neck, classifying the symptom as “objective” pulsatile tinnitus. This confirms the sound is physically present and is essentially an amplified awareness of blood flow moving through vessels near the ear’s delicate structures.
Primary Vascular Causes
The pulsing sensation originates from mechanical disturbances in blood flow, which can be categorized into issues of flow, awareness, or vessel structure. When blood flow is increased or encounters resistance, the smooth, silent laminar flow becomes turbulent, creating a distinct audible sound. Conditions that increase overall blood flow, such as severe anemia, an overactive thyroid gland (hyperthyroidism), or uncontrolled high blood pressure, can cause this generalized whooshing sound.
Localized turbulence is a common cause, often resulting from atherosclerosis, where plaque buildup narrows the carotid arteries in the neck. This narrowing causes blood to rush through the constricted area, producing a loud sound, or bruit, that the nearby ear structures pick up. Similarly, certain venous abnormalities, such as stenosis (narrowing) of the transverse or sigmoid sinuses, can create turbulence that is transmitted to the cochlea.
Structural issues involving the blood vessels or surrounding tissue are also frequent culprits. Highly vascularized tumors, like paragangliomas (glomus tumors), can grow near the middle ear or jugular bulb, pressing on vessels and creating turbulent flow. Abnormal connections between arteries and veins, known as arteriovenous malformations or fistulas, allow blood to pass too quickly from high-pressure arteries to low-pressure veins, generating a loud, pulsating noise. Finally, an increased awareness of normal blood flow can occur if the middle ear is compromised, such as with certain types of conductive hearing loss. This hearing loss effectively masks external sounds, making the patient more keenly aware of their body’s internal noises, including the rhythmic pulse of blood. In some cases, conditions like idiopathic intracranial hypertension (IIH) cause increased pressure around the brain, which can restrict the large veins and lead to venous stenosis, manifesting as pulsatile tinnitus.
How Doctors Diagnose the Source
The diagnostic process begins with a thorough medical history, focusing on the sound’s onset, laterality, and association with symptoms like headaches or vision changes. During the physical examination, the physician uses a stethoscope to listen over the patient’s ear and neck (auscultation) to determine if the sound is objective, immediately narrowing the focus to a vascular cause.
If a vascular cause is suspected, specialized imaging is used to visualize the blood vessels and surrounding anatomy. Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) provide detailed images of the arteries and veins, useful for identifying soft tissue abnormalities, aneurysms, or abnormal vessel courses. A Computed Tomography (CT) scan of the temporal bone examines the bony structures of the ear and skull base. This helps to detect bony erosions, structural abnormalities, or the presence of tumors. These advanced imaging techniques allow doctors to pinpoint the exact location and nature of the underlying issue, which is identified in up to 70% of cases.
Treatment Strategies
Treatment for pulsatile tinnitus is highly individualized, focusing on resolving the specific underlying condition identified during diagnosis. For circulatory issues like high blood pressure, anemia, or hyperthyroidism, management involves medication and lifestyle adjustments. By normalizing blood flow, the turbulent sound often diminishes or disappears.
When the cause is structural, such as a tumor or an arteriovenous malformation, intervention involves specialized procedures. Highly vascular tumors may be treated with surgery or pre-surgical embolization to block the blood supply. For venous sinus stenosis, stenting can be performed to open the narrowed vein, reducing localized turbulence.
If no specific treatable cause is found, management shifts to symptom control. This involves sound therapy, where low-level background noise is used to mask the internal whooshing sound. Cognitive behavioral therapy can also help patients reduce the emotional distress and anxiety associated with the noise.